女性盆腔良性占位性病变的MRI诊断与鉴别诊断

目的 评价MRI对女性盆腔良性占位病变的诊断价值.方法 回顾性分析33例经手术病理证实的盆腔良性占位病变患者的MRI征象.结果 33例手术病理检出64个病灶,MRI检出59个(59/64,92.2%),3个子宫肌瘤及2个成熟畸胎瘤MRI未检出而漏诊(5/64,7.8%).MRI检出的59个病灶中57个病灶部位与手术病理一致,准确性为96.6%(57/59),56个病灶MRI诊断结果与手术病理相符,符合率94.9%(56/59).子宫病变主要表现为实质性肿块或子宫内膜增厚;卵巢病变主要表现为囊性、囊实性肿块影.结论 MRI对盆腔良性肿块的定位具有很高的准确性,对良性肿块的鉴别诊断亦具有较高的准确性.     

女性盆腔囊性病变的MRI诊断与鉴别诊断价值

目的:探讨女性盆腔囊性病变的MRI表现及其诊断和鉴别诊断价值.方法:回顾性分析经手术病理证实的34例女性盆腔囊性病变的MRI表现.结果:卵巢囊腺瘤10例,卵巢囊腺癌4例,卵巢囊性畸胎瘤4例,卵巢子宫内膜异位囊肿6例,卵巢囊肿3例,盆腔脓肿4例,盆腔腹膜间囊肿1例,盆腔淋巴管瘤1例,盆腔囊性畸胎瘤1例.术前MRI准确定位32例(94.1%),准确判断病理组织类型30例(88.2%).结论:MRI是中等女性盆腔囊性病变的重要影像学手段,能明确病变范围以及病变与周围组织的关系,大多数病例可明确诊断.     

3.0T MRI评价原发性卵巢肿块:MRI和DWI对其分类的价值

目的:探讨3T MRI对原发性卵巢肿块的鉴别诊断价值。方法:95个经组织病理学证实的原发性卵巢肿块均行MRI检查,比较良恶性病灶的基本特征、成份以及其在常规MRI和DWI图像的信号特点。结果:本组资料包括18例单纯性卵巢囊肿,22例子宫内膜异位囊肿,26例良性和29例恶性卵巢肿瘤。多数良性肿瘤表现为实性(6/26)和囊性伴有间隔(7/26)。恶性肿瘤(13/29)多表现为囊性伴有实性结节。患者的年龄和肿块的最大径在良、恶性卵巢肿瘤间无统计学显著差异(P=0.339,P=0.082)。在卵巢良性病变和恶性病变间,病灶的传统MRI和DWI信号特点无显著差异(P=0.244,P=0.073),但ADC值在两者间具有统计学显著差异(P=0.000)。结论:3T MRI可以很好地区分原发性附件肿块的信号特点。传统MRI和DWI信号特点无助于鉴别肿块的良、恶性,但ADC值有助于鉴别肿块的良恶性。     

女性盆腔囊实性病变的MRI征象分析

目的 :探讨女性盆腔囊实性病变的MRI征象及其诊断与鉴别诊断价值。方法:回顾性分析47例(54个病灶)经MRI复查随访及术后病理证实的囊实性病变的MRI征象。结果:47例术后病理查出54个病灶,良性31例,恶性13例,交界性3例。卵巢源性病灶44个,其中非炎性病变42个包括卵巢囊肿17个(单纯囊肿6个、单纯出血性囊肿1个、子宫内膜异位囊肿7个、卵巢滤泡囊肿1个、黄体囊肿2个),卵巢囊腺瘤12个,卵巢畸胎瘤6个,卵巢囊腺癌5个,卵巢颗粒细胞瘤1个,卵巢转移癌1个;炎性病变包括卵巢脓肿1个,卵巢输卵管积脓1个;子宫源性10个,其中子宫肌瘤变性7个,子宫内膜样癌3个。诊断定位准确46例,定性准确43例。结论:MRI定位定性准确率较高,特别是DWI对女性盆腔囊实性病变定性的诊断具有独特优势。     

女性盆腔囊性病变的多层螺旋CT鉴别诊断

目的：分析女性盆腔囊性病变的多层螺旋CT（MSCT）图像特征,提高MSCT诊断女性盆腔病变的准确性。方法选取2010-2013年收治的女性盆腔囊性病变患者68例（89个病灶）,均经病理及手术证实,所有病例行多层螺旋CT平扫、增强扫描及多平面重建,分析其CT图像特征及诊断结果。结果本组68例患者共发现89个囊性病灶,囊性病灶大小15～209 mm;其中良性74个,恶性15个;CT诊断定位正确81个病灶（91％）,定性正确69个病灶（78％）。其中卵巢囊性畸胎瘤12例14个病灶;卵巢囊腺瘤10例12个病灶;卵巢囊腺癌4例9个病灶;卵巢内膜异位囊肿11例15个病灶;卵巢囊肿16例21个病灶;输卵管脓肿6例9个病灶;盆腔囊性感染性包块5例5个病灶;其他4例。结论各种盆腔病变的MSCT扫描图像均有较明确的特征性表现,MSCT对女性盆腔囊性肿块定位及定性诊断具有较高价值。     

MR DWI及联合血清CA125对卵巢占位性病变定性诊断的价值

目的探讨MR扩散加权成像及联合血清CA125对卵巢占位性病变定性诊断的价值。方法利用西门子3.0T磁共振后处理工作站对病理证实的75例卵巢占位性病变囊实性部分ADC值进行测量,对卵巢良恶性占位性病变ADC值采用独立样本t检验进行比较并应用受试者工作特征曲线(ROC)确定其最佳诊断阈值;卵巢囊、实性占位性病变各组间比较采用单向方差分析;MRI及MRI+CA125两种方法分别与病理采用配对计数资料的2检验和Kappa检验进行分析。结果卵巢良、恶性占位性病变囊性部分ADC值比较,有统计学意义(P=0.000),ROC曲线下面积为0.915,最佳良恶性阈值为2711.6×10-3 mm2/s;卵巢良、恶性占位性病变实性部分ADC值比较,有统计学意义(P=0.001),ROC曲线下面积为0.858,最佳良恶性阈值为920.3×10-3 mm2/s;卵巢囊性占位性病变整体组间比较有统计学意义(P<0.05),组间多重比较,卵巢恶性肿瘤及卵巢子宫内膜异位症分别与其余各组间均有统计学意义(P<0.05);卵巢实性占位性病变整体组间比较有统计学意义(P<0.05),组间多重比较分析,卵巢恶性肿瘤与其余各组间均有统计学意义(P<0.05);MRI、MRI+CA125两种方法分别与病理吻合分析,MRI诊断卵巢良恶性占位性病变灵敏度为90.0%,特异度为82.2%,准确度为85.3%,约登指数为72.2%;MRI+CA125联合诊断卵巢良恶性占位性病变灵敏度为93.3%,特异度为86.7%,准确度为89.3%,约登指数为80.0%;检验吻合系数MRI+CA125(0.783)>MRI(0.703),表明MRI+CA125联合诊断与病理的吻合度更好。结论 MR扩散加权成像及联合血清CA125对卵巢占位性病变定性诊断具有重要的价值,可以提高卵巢占位性病变早期诊断及鉴别诊断水平。     

甲状腺囊性病变的CT鉴别诊断

目的:探讨甲状腺囊性病变的CT鉴别诊断价值。方法:回顾性分析47例甲状腺囊性病变的CT表现及其 病理改变,研究各种甲状腺病变的CT表现特点和CT鉴别诊断价值。结果:甲状腺囊性肿块根据形态可分为3种类型: 单纯囊肿型、囊壁结节型和厚壁肿块型,其中良性病变以单纯囊肿型表现为主(28/34),恶性病变以厚壁肿块型多见(11/ 13),良、恶性病变的CT表现,差异有显著性意义(P<0.05)。结论:根据甲状腺囊性病变的CT表现特点,能够对其做出 鉴别诊断,尤其能对病变的良恶性作出正确评估。     

MRI对卵巢良恶性病变的鉴别诊断价值

目的:探讨MRI对卵巢良恶性疾病的鉴别诊断价值。方法:分析66例经手术病理证实的卵巢疾病的MRI特征,良性病变36例,其中卵巢囊肿7例,巧克力囊肿5例,畸胎瘤10例,炎症肿块4例,浆液性囊腺瘤6例,粘液性囊腺瘤4例;恶性病变30例,其中浆液性囊腺癌10例,粘液性囊腺癌11例,内胚窦瘤4例,Krukenberg’s肿瘤5例。所有患者行常规扫描,平扫发现病灶行增强扫描,术后对所有病变行MR征象与病理结果对照分析。结果:MRI检查能很好显示卵巢病变的特征,其定位诊断100%,诊断的敏感性93%,特异性94%,准确性94%,卵巢癌分期准确性达85.0%。结论:MRI对卵巢良恶性病变的鉴别诊断价值大,并可提供卵巢癌分期所需的信息,增强扫描可进一步提高MR对卵巢癌的诊断及分期的准确性。     

子宫附件良性囊性病变的MRI诊断

目的:探讨女性附件良性囊性病变的MRI表现特点,提高其诊断及鉴别诊断水平。方法:搜集我院近三年来经手术及病理证实的110例附件区良性囊性病灶,对其MRI表现作回顾性分析,讨论其MRI表现特点。结果:110例附件良性囊性病灶中,卵巢囊性病变最多,占所有病例的89%(98/110)。其中单纯性囊肿28例(25%,28/110),卵巢囊腺瘤27例(25%,27/110),畸胎瘤22例(20%,22/110),子宫内膜异位囊肿15例(14%,15/110),占所有病例的84%(92/110)。28例单纯性囊肿信号均匀,其中26例(93%,26/28)T1WI呈低信号,T2WI呈高信号。27例卵巢囊腺瘤中,24例可见分隔,2例可见壁结节。22例囊性畸胎瘤中21例可见明显脂质信号。所有15例子宫内膜异位囊肿T1WI和T2WI均呈高信号,部分病灶内可见液液分层。结论:大多数女性附件良性可性病变的MRI表现特征性较明显,可明确诊断。     

卵巢囊性病变的MRI诊断价值

目的探讨MRI对卵巢囊性病变的诊断价值。方法收集我院病理证实的卵巢囊性病变39例,回顾性分析其MRI表现。结果良性32例,交界性4例,恶性3例。其中黄体囊肿2例,滤泡囊肿1例,单纯性囊肿8例,巧克力囊肿7例,卵巢输卵管积脓4例,囊腺瘤9例,囊腺癌3例,囊性畸胎瘤5例。本组MRI诊断卵巢囊性病变的准确性为92.3%,灵敏度为90.9%,特异度为94.1%,阳性预测值为95.2%,阴性预测值为88.9%。结论 MRI能清晰显示卵巢囊性病变本身及毗邻结构的形态学和信号改变,对卵巢囊性病变的诊断及鉴别诊断具有重要价值。     

Evaluation of positron emission tomography with tracer 18-fluorodeoxyglucose in addition to magnetic resonance imaging in the diagnosis of ovarian cancer in selected women after ultrasonography

OBJECTIVE: To determine whether positron emission tomography (PET) with tracer 18-fluorodeoxyglucose (FDG-PET) yields additional information in the diagnosis of malignancy compared with magnetic resonance imaging (MRI) findings in selected women after screening for ovarian masses by ultrasonography (US). METHODS: After 49 patients were screened by US and physical examination (including a pelvic examination) by 2 experienced gynecologic oncologists, 38 patients suspected of having ovarian cancer were enrolled in the study. All 38 underwent MRI and FDG-PET. The results of the histologic findings were used to assess the accuracy of the imaging findings. RESULTS: Of the 38 women, 23 had malignant lesions and 15 had benign lesions. Magnetic resonance imaging, PET, and MRI with FDG-PET diagnoses had sensitivities of 91%, 78%, and 91%, respectively; specificities of 87%, 87%, and 87%, respectively; and diagnostic accuracy of 92%, 82%, and 92%, respectively. CONCLUSION: The addition of FDG-PET to MRI does not yield significant additional information for differentiation of benign from malignant ovarian masses in selected women after US.     

Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review

This article reviews the value of magnetic resonance imaging (MRI) for the diagnosis of ovarian tumors especially when ultrasonography is indeterminate. Although ultrasonography is the first imaging technique used to investigate suspected pelvic masses, it has a limited capacity for tissue characterization. In addition to morphological characteristics, many tissue parameters such as T1, T2, perfusion, and diffusion contribute to signal intensity, so MRI is able to identify various types of tissue contained in pelvic masses. Magnetic resonance imaging helps to locate large solid masses and to distinguish benign from malignant ovarian tumors, with an overall accuracy of 88% to 93% for the diagnosis of malignancy. The aims of this review are 3-fold. First, we review state-of-the-art and usual MRI techniques and published findings. Second, we recall the MR features most useful for assessing the main ovarian tumors. Finally, we discuss the relevance of various features for distinguishing between benign, borderline, and invasive ovarian tumors.     

常规MRI及DCE-MRI在卵巢肿瘤及肿瘤样病变诊断中的应用

目的:提高常规MRI及DCE-MRI在卵巢肿瘤及肿瘤样病变的诊断准确率。方法:回顾性分析44例我院收治并经手术病理证实为卵巢肿瘤及肿瘤样病变的常规MRI及DCE-MRI影像表现。平扫参考指标:病灶大小(最大径)、形状(规则/不规则)、有无包膜、囊壁/分隔厚度、实性成分比例、T2WI信号、ADC值、盆腔积液;DCE-MRI参考Ktrans、Kep以及Ve值。结果:MRI平扫显示良、恶性肿瘤的病灶大小、形状、实性成分比例、囊壁/分隔厚度、T2WI信号混杂程度、盆腔积液量及ADC值差异有统计学意义(P<0.05);上述7项中ADC值参考价值最大,ADC取1.09×10^-3)mm^2/s为良恶性肿瘤阈值,小于阈值,考虑恶性。DEC-MRI良性肿瘤实性部分Ktrans、Kep以及Ve值显著低于恶性肿瘤,差异有统计学意义(P<0.05),Ktrans值参考价值最大,Ktrans值取0.091/min为良恶性肿瘤阈值,大于阈值,考虑恶性。分别以ADC值及Ktrans值敏感度、特异性、准确度、阳性预测值及阴性预测值代表MRI平扫及DCE-MRI各项指标,得出常规MRI敏感度85.7%、特异性91.3%、准确度88.6%、阳性预测值90.0%、阴性预测值87.5%;DCE-MRI上述各项指标为72.7%、81.8%、77.3%、80.0%、75.0%;常规MRI联合DCE-MRI检查敏感度95.2%,特异性100.0%,准确度97.7%,阳性预测值100.0%,阴性预测值95.8%。结论:常规MRI联合DCE-MRI用于卵巢肿瘤及肿瘤样疾病诊断及鉴别诊断能够提高诊断准确率。     

A prospective study of Tc-99m MIBI in the differential diagnosis of pelvic masses in female patients

PURPOSE: This study evaluated the feasibility of Tc-99m MIBI scintigraphy in the differential diagnosis of pelvic masses in female patients before operation. METHODS: Seventy-one patients with pelvic masses were studied with planar imaging over the abdomen and pelvis 5, 15, 30, and 60 minutes after injection of 740 MBq (20 mCi) Tc-99m MIBI. The uptake of the masses was graded, and other abnormal signs, such as intestinal involvement, lymph node involvement, or peritoneal fluid collection, were also considered in image interpretation. An exploratory laparotomy was performed 3 days to 2 weeks after imaging. The scintigraphic diagnosis was compared with that of computed tomography (CT), CA-125 measurement, and pathologic analysis. RESULTS: Forty-one of 46 pelvic masses with no activity were proved benign. Eighteen of 25 with a fixed, focal uptake were malignant. In 19 of 23 masses, intestinal activity noted within 30 minutes was caused by metastases. All three cases with lymph node involvement and six cases with ascites were confirmed malignant. Combining focal uptake with intestinal involvement correctly indicated 22 of 23 malignant conditions before operation, whereas negative scans identified 41 of 48 benign lesions. Four of seven false-positive lesions had a higher cellular component. The diagnostic performance of Tc-99m MIBI is better than that of CT and CA-125 tests, because CT had eight false-positive and three false-negative results, whereas CA-125 had 12 false-positive and 3 false-negative results, respectively. CONCLUSIONS: Tc-99m MIBI is useful for differentiating benign and malignant pelvic masses in female patients. A fixed focal uptake or intestinal uptake of the radiotracer suggests malignancy, with diagnostic sensitivity, specificity, accuracy, and positive and negative predictive values of 95.6%, 85.4%, 88.7%, 75.9%, and 97.6%, respectively, in the current prospective study.     

卵巢肿瘤和肿瘤样病变的CT诊断

目的:分析卵巢肿瘤的CT表现,提高CT诊断卵巢肿瘤的准确性.材料和方法:分析我院经手术病理证实的53例卵巢肿瘤(其中良性22例, 恶性25例)与6例肿瘤样病变的CT表现.结果:良性卵巢肿瘤CT检出21例(检出率为95.5%),术前CT诊断为良性肿瘤19例(准确率86.4%);CT检出恶性肿瘤22例(检出率88%).术前CT诊断恶性20例(准确率80%);肿瘤样病变6例, CT全部检出;所有的病例,CT检出率为92.5%,良恶性定性准确率为84.9%.结论:CT能清晰显示盆腔结构,可提供对肿瘤的定位、定性、病变范围的可靠信息.     

扩散峰度成像与DWI在卵巢实性病灶良恶性鉴别诊断中的应用

目的:探讨扩散峰度成像(DKI)与DWI在卵巢实性病灶良恶性鉴别诊断中的应用价值。方法:回顾性分析87例卵巢实性病灶的临床及影像资料,患者均行卵巢MRI常规平扫、DWI、DKI检查,分别获取ADC值、平均扩散峰度(MK)和平均扩散率(MD),评估DWI、DKI对卵巢良恶性病变的鉴别诊断价值。结果:与卵巢恶性病变相比,卵巢良性病变的ADC值、MD明显升高,MK明显降低(均P<0.05)。ADC、MK、MD联合诊断卵巢良恶性病变的AUC较三者单独及MK联合MD诊断诊断的AUC大。结论:与DWI相比,DKI对卵巢良恶性病变鉴别诊断价值略高;DWI联合DKI可提高对卵巢良恶性病变鉴别诊断效能及卵巢实性病灶检出率。     

动态增强MRI时间信号强度曲线在卵巢良恶性肿瘤鉴别中的价值

目的探讨动态增强MRI时间信号强度曲线(TIC)鉴别卵巢肿瘤良恶性的价值。方法收集2016年1月—2017年8月间于我院超声检查发现盆腔附件肿块的71例女性病人,年龄14～78岁,中位年龄52岁。所有病人行MRI常规及动态增强检查后经手术获得病理结果。利用工作站在肿块实性区和正常子宫外肌层设置兴趣区获取TIC,以子宫外肌层强化曲线为基准,对卵巢肿块实性区的TIC类型进行校正,分析曲线类型与良恶性卵巢肿瘤的关系。采用χ~2检验比较良恶性肿瘤间3种TIC类型差异。结果 71例病人中包括卵巢恶性肿瘤40例,良性肿瘤26例,交界性肿瘤5例。上述3种肿瘤的TIC类型的差异有统计学意义(P0.05)。良性肿瘤以Ⅰ型TIC为主(73.1%),恶性肿瘤以Ⅲ型TIC为主(77.5%)。MRI+TIC鉴别肿瘤良恶性的敏感度、特异度、阳性预测值和阴性预测值较单独常规MRI检查各指标均有不同程度提高。结论动态增强MRI及其TIC对卵巢良恶性肿瘤具有重要的鉴别诊断价值。